A 44 year old female presented with fever, dysphagia, hiccups and weight loss for 3 months

A 44 year old female presented with low grade fever, dysphagia, hiccups and weight loss for 3 months. On examination BP was 100/60, regular pulse 100bpm, muffled heart sounds with pericardial friction rub. ECG was of low voltage and chest X-ray showed enlarged cardiac shadow. ESR was 70mm/hour. PPD 9mm. Echocardiogram revealed large pericardial effusion

a) What is diagnosis?

b) How would you treat pericardial effusion if it is recurrent?

c) What are the treatment options available?

d) Are steroids indicated?

Answers:

a.      Tuberculous pericardial Effusion
b.      Pericardiocentesis, pericardial window pericardiotomy
c.       Triple therapy INH/Rifampicin/Ethambutol for 9 months
d.      Constrictive tuberculous pericarditis steroids are given, but in HIV with Tuberculous pericarditis without constriction , steroids should not be given.

Reference:

Chapter 40, page 667 – Pericardial disease- Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC
Reuter H, Burgess LJ, Louw VJ, Doubell AF. Experience with adjunctive corticosteroids in managing tuberculous pericarditis. Cardiovasc J S Afr 2006;17:233-238 [Medline]

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